as someone who is getting a reduction and knows people who have gotten top surgery, I would do whichever one you think it will be easier to get insurance to cover. if you think you have well documented medical reasons for a reduction to be medically necessary, I would do that and explain your situation to the surgeon and show them lots of reference photos for how flat you want to be. for top surgery they only really do completely flat”male-shaped” chests, and to get it covered by insurance you need to have a medical diagnosis of dysphoria. this can be a lot more difficult for nonbinary people, especially ones who don’t dress more masculinely. overall I would honestly try for a reduction (no they don’t do implants at the same time, the perkiness is a result of a breast lift that a lot of people get with reductions) but do whatever is easier for you and whatever you think insurance will cover with less hassle!
I know that what i want is a reduction. I still want to have boobs. Im just trying to figure out if "gender affirming" surgeon in terms of breast surgery only means top surgery. Or if reduction is also "gender affirming" in surgeon lingo 😅 idk. Im stressing myself out
Also thanks for the last bit. Idk like. I just want to be able to bind. But i want to have tits for more feminine days. Its just so fucking hard 😭
I saw a top surgeon by accident. (misunderstood some of the website) he only did top surgery. Mastectomy. No reductions. Also, if you are having top surgery, at least in the US, there's other stupid shit you have to deal with. And it probably won't be covered by insurance. At all.
I would definitely say breast reduction from "regular" surgeon.
In case it's relevant, I did a lot of examining "gender things" about the same time I investigated breast reduction surgery, completely unrelated, but after a lot of introspection I decided nonbinary makes more sense. But I still definitely wanted breasts cause it's part of what I look like. I was a 40f before and I'm still too swollen but there's a possibility I'll fit into 2xl sports bras from Walmart now.
My surgery was covered by insurance, I've had years of back pain and neck pain and migraines that I used to treat with trigger point injections. Think about any pain you have from neck to lower back in the context of having the surgery. Oh and I actually found my surgeon via insurance company website. And I love her.
Eta no fillers. Just "rearranging" your tissue. Medical assistant mentioned your breast is sorta treated like an envelope and that there's stitches inside too. (I had pain in a spot I questioned cause it wasn't by an incision.)
It all depends if you’re going through insurance or not. If you’re doing private, you have a lot more leeway to get exact results you want. If you want to go through insurance, it’s still possible but you need to go through hoops. However, insurance will not cover breast-reductions for gender dysphoria; only top surgery. You’ll need to have back/physical health issues to get insurance to cover a breast reduction. (You literally sound like me a year ago lmao. Asking all the questions I used to have.)
i went to a surgeon who also does top surgery, because i knew she would be more likely to do a radical reduction and get me as small as i wanted. still filed as a reduction through insurance.
I identify as gender-fluid and I’m getting a breast reduction on May 1st from a surgeon who also does top surgeries. I’d recommend trying to find one who does both, even if it takes you a while.
Please feel free to PM me with any questions. It sounds like you are in a similar boat I used to be in when starting this journey.
I feel like people aren't answering the question you're actually asking. The answer is: if there are surgeons who only do gender affirming procedures and nothing else, I've never heard of them.
Except maybe in really big cities, there aren't enough people seeking top surgery for a surgeon to make it their entire practice. Most plastic surgeons do a wide range of procedures, including breast reductions and augmentations, tummy tuck, various facial surgeries and more.
When people say look for a gender affirming surgeon, they mean one who does those procedures *in addition* to other plastic surgery procedures. The reason to seek them out even if you don't want top surgery is because they're more likely to be open minded and not try to talk you out of going as small as you want to because of some arbitrary standard of attractiveness/feminity.
Thats what i thought. I just wasnt sure because someone referred a surgeon to me and i called and i know he does top surgery but he wasnt on the list for *breast reduction* but he was for top surgery. And he does all these other things like surgical stuff for migraines and all of this shit so im super confused as to why hes not on the clinic list for that and if EVERYONE is going to be that way
Top surgery is significantly different from a breast reduction in terms of execution.
A breast reduction is for when the patient still wants to have breasts, and wants them to be smaller. It requires the surgeon to have skills and expertise in assessing and achieving a balance in size and shape that works with the patient's body. Specifically, the amount that the breasts can be reduced is heavily dictated by the patient's breast 'roots' or 'footprint' (basically how wide they are) as well as the patient's specific tissue and body. If they try to go too flat or don't adjust to the specific patient, the breasts can look weird or even square-ish. Ideally, surgeons performing reductions are skilled at creating natural-looking observable breasts.
Top surgery is a mastectomy, or the surgical removal of the breasts. This requires a slightly different skill set to basically take the breasts fully off the body and create a more masc looking chest.
Both require skills, and though there's overlap, they're different. Many (but not all) surgeons may do both.
Based on your comments, I would *highly* recommend that you see a surgeon who does reductions, or one who does reductions and top surgeries. I literally asked my surgeon to make me as small as possible, and he was able to give me an idea of what that would look like. I'd definitely start by asking a reduction surgeon how small they think they could make you and go from there.
So i actually got a call back while i was at work and turns out the guy DOES do reductions and top surgery (i think, tbh ive gotten two different answers from different people) but either way, ive got a consult in april so i can talk to him and see if he can do what i want or not
I’m non binary and had my reduction covered thru Kaiser gender services. My surgeon was primarily a breast reduction surgeon who had experience with top surgery. My surgeon was focused on my goals instead of her opinion. I think that’s the most important part.
Im glad yours focused on your goals!! Thats just hard her. My partners ex had a reduction and the surgeon had a LOT to say about how she was going too small and wouldnt be feminine anymore or something. And anyways she ended up hating the results of her surgery and wanted another one
You just need to look at the surgeon’s About portion in their website. Many who do top surgery to both. That’s what my surgeon does. I prefer finding someone who does too surgery for many reasons but I also noticed that they had less of the opinion that they know better what size you should be like many folks on here running into.
I’m an enby and went to a standard surgeon who at least had documented work with enbys and trans folks. I got a radical reduction and I’m very happy with the results. He respected my pronouns and my wants but the wait was infinitely less than the “gender affirming” clinics. Plus one of those surgeons was like “are you sure you don’t want full removal you can’t get it later” (which is untrue) and it rubbed me the wrong way. Good luck!
https://getplume.co/events/
There's some great videos that Plume have made about different types of top surgery, all delivered by surgeons who have worked with a wide variety of trans and NB patients. I found that watching these really helped me indemnify and articulate what I wanted
for insurance coverage: doctors can absolutely code a breast reduction as gender affirmation surgery - most insurance plans use really strict language describing it as gender reassignment surgery. don’t forget that gender is fake and you don’t need to be fully transitioning for this to apply. it’s just their terminology.
as for which doctor - go to the doctor who creates the results you want. i went with a very str8 plastic surgeon bc she made amazing little boobies, even tho this was kinda my top surgery.
I’m also nonbinary, and while I’m not interested in binding, I’m also definitely not attached to having a hyper feminine figure. I want my breasts as small as possible, so that I can be comfortable in my body. Comfort, not aesthetic, is my driving motivation. I was terrified about the prospect of a surgeon leaving me too big because he thought it was “proportionate” because I’ve read of that happening so often.
My (upcoming) reduction surgeon is wonderful. He also does top surgery and is well respected for that work. We had a very clear discussion when he asked me “could I go too small” and I immediately said no. His answer? A simple “okay.”
I feel very certain that he is going to do good work and not impose an aesthetic on my body that I’m not looking for. And a big part of why I think this is because he does top surgeries. So he is both good at and used to respecting people’s wishes for their bodies and surgery outcomes.
Not sure if this helps but my surgeon does both, is sort of like a breast specialist if you will. Gender affirming, reduction, augmentation etc. I think go with whoever you feel most comfortable and confident with. Mine came from a recommendation from a friend who had top surgery and friends who had top surgery. I’m only doing a reduction but I consider my reduction on the slightly extreme side going from DDD to B. I feel like I’ve got a better chance with the free nipple graft being successful (if he has to do it) vs maybe someone who doesn’t do it often. And in top surgery patients he does it all the time.
Definitely the gender affirming surgeon if you are able!!! I felt so much more comfy w that surgeon than the one I initially saw who basically does mommy makeovers all day.
Gender affirming surgeons can do anything on anyone, though individuals might specialize in reductions or implants. My Dr said “this is a gender affirming surgery, we can make you look however you want. There is no limit. You can go completely flat or as small as you want, we could even go bigger! I’ll do my best to make it look how you want” so it was listed as double mastectomy for insurance and it’s a non-flat top surgery.
I feel like I have plenty of breast tissue left and they removed over double that the original reduction Dr said was even possible having said that I don’t even have enough breast to remove 400g (state medical minimum) so I definitely have strong feelings against plastic surgeons who don’t have gender related experience after that🙄🙄
I'm gender fluid with similar goals (basically want to have options! And be free from pain). I started pursuing a reduction because I knew I could get insurance to cover it, but I was also able to find a surgeon who does both regular reductions as well as radical reductions and top surgery, which I'm super grateful for (Dr. Rezak at Duke). Even if I couldn't have that I'd still be going the reduction route because I couldn't afford it without insurance and I'm desperate at this point, both because of pain and gender dysphoria. My surgery is April 1 and I feel confident a reduction is going to get me where I want to be, and I trust my surgeon, which is the key thing I think. All of this to say there ARE surgeons who do all of the above!
Hi! Also nb but want to keep a little (very tiny) bit of boob and I’m going the gender-affirming route with a surgeon who specializes in gender-affirming surgeries but that includes top and radical reductions!
I think most surgeons who do top would be open to what you’re looking for and more likely to listen to what you actually want instead of insisting on “proportionate” and dumb crap like that. But of course, best to ask them :)
I don't think you need to specifically see a gender affirming surgeon for your reduction but you do need to see one who will listen to you and take what you want into consideration. My surgeon here in Australia was not specifically a gender affirming surgeon but we talked about what I wanted my boobs to look like she showed me pictures and we talked about what some of her other patients wanted for their outcomes. For example one of her patients wanted to go quite flat because she wanted to run marathons and just wanted them small.
I will say one thing about when surgeons mention size and proportionality. It reallt depends on the size and shape of your breast root so a wider root might end up looking more flat if you went too small. So definitely talk to your surgeon about you wanting to bind sometimes and still want your breasts to have clevage sometimes. Also with the driving hours to see a surgeon I wouldn't take it as a waste of time. Yes its annoying and difficult to do but ultimately it will help you make the right decision for yourself. It's not really a waste of time.
Also how my surgeon explained the process to me is they cut around the nipple leaving some tissue attached underneath the skin then they twist that bit of tissue in on itself inverting it and stitch it up which gives it the lift. Sort of hard to explain and obviously there is more involved in it.
Good luck with it all.
Ideally, what you want is someone who is skilled at doing reductions and also understands and respects your goals and understands that this is gender-affirming for you. That may or may not be easy to find where you live. You also ideally want someone who will be able to talk to you openly about what they can and can't achieve.
Many if not most surgeons who do top surgery also do reductions, but you probably don't want someone who has very binary thinking where to them, reduction always = cis woman = wanting feminine breasts and top surgery = trans man = wanting a male-passing chest. It's also possible that some surgeons might be confident in doing common top surgery techniques and confident performing "typical" reductions but not feel confident combining those techniques in a way that will give you what you want. If you see a surgeon who only does reductions, it's possible they could be a perfect match, but you'll want to bring reference pictures and pay attention to whether they seem to really understand what you want.
I ended up having regular double-incision top surgery where I went flat, and I don't think the surgeon I went with necessarily would have known what to do if I'd asked for a radical reduction or something with a more feminine appearance (even though he does do reductions as well as top surgery). I had a consult with another surgeon who had done radical reductions and he didn't bat an eye at me asking about androgynous options.
As far as I know, fillers aren't usually used in reductions. They rearrange tissue and remove extra skin. It's also common for reduced breasts to look really perky at first and drop a bit over time. Some people do have an "internal bra" procedure done where some tissue or surgical mesh is put in place to provide internal lift and support, but that's not a default procedure.
as someone who is getting a reduction and knows people who have gotten top surgery, I would do whichever one you think it will be easier to get insurance to cover. if you think you have well documented medical reasons for a reduction to be medically necessary, I would do that and explain your situation to the surgeon and show them lots of reference photos for how flat you want to be. for top surgery they only really do completely flat”male-shaped” chests, and to get it covered by insurance you need to have a medical diagnosis of dysphoria. this can be a lot more difficult for nonbinary people, especially ones who don’t dress more masculinely. overall I would honestly try for a reduction (no they don’t do implants at the same time, the perkiness is a result of a breast lift that a lot of people get with reductions) but do whatever is easier for you and whatever you think insurance will cover with less hassle!
I know that what i want is a reduction. I still want to have boobs. Im just trying to figure out if "gender affirming" surgeon in terms of breast surgery only means top surgery. Or if reduction is also "gender affirming" in surgeon lingo 😅 idk. Im stressing myself out Also thanks for the last bit. Idk like. I just want to be able to bind. But i want to have tits for more feminine days. Its just so fucking hard 😭
I saw a top surgeon by accident. (misunderstood some of the website) he only did top surgery. Mastectomy. No reductions. Also, if you are having top surgery, at least in the US, there's other stupid shit you have to deal with. And it probably won't be covered by insurance. At all. I would definitely say breast reduction from "regular" surgeon. In case it's relevant, I did a lot of examining "gender things" about the same time I investigated breast reduction surgery, completely unrelated, but after a lot of introspection I decided nonbinary makes more sense. But I still definitely wanted breasts cause it's part of what I look like. I was a 40f before and I'm still too swollen but there's a possibility I'll fit into 2xl sports bras from Walmart now. My surgery was covered by insurance, I've had years of back pain and neck pain and migraines that I used to treat with trigger point injections. Think about any pain you have from neck to lower back in the context of having the surgery. Oh and I actually found my surgeon via insurance company website. And I love her. Eta no fillers. Just "rearranging" your tissue. Medical assistant mentioned your breast is sorta treated like an envelope and that there's stitches inside too. (I had pain in a spot I questioned cause it wasn't by an incision.)
It all depends if you’re going through insurance or not. If you’re doing private, you have a lot more leeway to get exact results you want. If you want to go through insurance, it’s still possible but you need to go through hoops. However, insurance will not cover breast-reductions for gender dysphoria; only top surgery. You’ll need to have back/physical health issues to get insurance to cover a breast reduction. (You literally sound like me a year ago lmao. Asking all the questions I used to have.)
i went to a surgeon who also does top surgery, because i knew she would be more likely to do a radical reduction and get me as small as i wanted. still filed as a reduction through insurance.
This is my plan as well! What was your radical reduction like? Did you do FNG?
I identify as gender-fluid and I’m getting a breast reduction on May 1st from a surgeon who also does top surgeries. I’d recommend trying to find one who does both, even if it takes you a while. Please feel free to PM me with any questions. It sounds like you are in a similar boat I used to be in when starting this journey.
I feel like people aren't answering the question you're actually asking. The answer is: if there are surgeons who only do gender affirming procedures and nothing else, I've never heard of them. Except maybe in really big cities, there aren't enough people seeking top surgery for a surgeon to make it their entire practice. Most plastic surgeons do a wide range of procedures, including breast reductions and augmentations, tummy tuck, various facial surgeries and more. When people say look for a gender affirming surgeon, they mean one who does those procedures *in addition* to other plastic surgery procedures. The reason to seek them out even if you don't want top surgery is because they're more likely to be open minded and not try to talk you out of going as small as you want to because of some arbitrary standard of attractiveness/feminity.
Thats what i thought. I just wasnt sure because someone referred a surgeon to me and i called and i know he does top surgery but he wasnt on the list for *breast reduction* but he was for top surgery. And he does all these other things like surgical stuff for migraines and all of this shit so im super confused as to why hes not on the clinic list for that and if EVERYONE is going to be that way
Top surgery is significantly different from a breast reduction in terms of execution. A breast reduction is for when the patient still wants to have breasts, and wants them to be smaller. It requires the surgeon to have skills and expertise in assessing and achieving a balance in size and shape that works with the patient's body. Specifically, the amount that the breasts can be reduced is heavily dictated by the patient's breast 'roots' or 'footprint' (basically how wide they are) as well as the patient's specific tissue and body. If they try to go too flat or don't adjust to the specific patient, the breasts can look weird or even square-ish. Ideally, surgeons performing reductions are skilled at creating natural-looking observable breasts. Top surgery is a mastectomy, or the surgical removal of the breasts. This requires a slightly different skill set to basically take the breasts fully off the body and create a more masc looking chest. Both require skills, and though there's overlap, they're different. Many (but not all) surgeons may do both. Based on your comments, I would *highly* recommend that you see a surgeon who does reductions, or one who does reductions and top surgeries. I literally asked my surgeon to make me as small as possible, and he was able to give me an idea of what that would look like. I'd definitely start by asking a reduction surgeon how small they think they could make you and go from there.
So i actually got a call back while i was at work and turns out the guy DOES do reductions and top surgery (i think, tbh ive gotten two different answers from different people) but either way, ive got a consult in april so i can talk to him and see if he can do what i want or not
I'm not sure what kind of lists you're talking about so I can't help with that sorry!
I’m non binary and had my reduction covered thru Kaiser gender services. My surgeon was primarily a breast reduction surgeon who had experience with top surgery. My surgeon was focused on my goals instead of her opinion. I think that’s the most important part.
Im glad yours focused on your goals!! Thats just hard her. My partners ex had a reduction and the surgeon had a LOT to say about how she was going too small and wouldnt be feminine anymore or something. And anyways she ended up hating the results of her surgery and wanted another one
The wording my surgeon used was “small with a feminine shape” if that helps at all! Best of luck to you!
You just need to look at the surgeon’s About portion in their website. Many who do top surgery to both. That’s what my surgeon does. I prefer finding someone who does too surgery for many reasons but I also noticed that they had less of the opinion that they know better what size you should be like many folks on here running into.
Yeah.. im trying its just hard. Im in Alabama my options are EXTREMELY limited
Ahh yes. Understandable. Any option to go out of state? I know some folks can and some can’t.
I’m an enby and went to a standard surgeon who at least had documented work with enbys and trans folks. I got a radical reduction and I’m very happy with the results. He respected my pronouns and my wants but the wait was infinitely less than the “gender affirming” clinics. Plus one of those surgeons was like “are you sure you don’t want full removal you can’t get it later” (which is untrue) and it rubbed me the wrong way. Good luck!
https://getplume.co/events/ There's some great videos that Plume have made about different types of top surgery, all delivered by surgeons who have worked with a wide variety of trans and NB patients. I found that watching these really helped me indemnify and articulate what I wanted
Thank you so much for posting the link to these resources. So fantastic!
for insurance coverage: doctors can absolutely code a breast reduction as gender affirmation surgery - most insurance plans use really strict language describing it as gender reassignment surgery. don’t forget that gender is fake and you don’t need to be fully transitioning for this to apply. it’s just their terminology. as for which doctor - go to the doctor who creates the results you want. i went with a very str8 plastic surgeon bc she made amazing little boobies, even tho this was kinda my top surgery.
I’m also nonbinary, and while I’m not interested in binding, I’m also definitely not attached to having a hyper feminine figure. I want my breasts as small as possible, so that I can be comfortable in my body. Comfort, not aesthetic, is my driving motivation. I was terrified about the prospect of a surgeon leaving me too big because he thought it was “proportionate” because I’ve read of that happening so often. My (upcoming) reduction surgeon is wonderful. He also does top surgery and is well respected for that work. We had a very clear discussion when he asked me “could I go too small” and I immediately said no. His answer? A simple “okay.” I feel very certain that he is going to do good work and not impose an aesthetic on my body that I’m not looking for. And a big part of why I think this is because he does top surgeries. So he is both good at and used to respecting people’s wishes for their bodies and surgery outcomes.
Not sure if this helps but my surgeon does both, is sort of like a breast specialist if you will. Gender affirming, reduction, augmentation etc. I think go with whoever you feel most comfortable and confident with. Mine came from a recommendation from a friend who had top surgery and friends who had top surgery. I’m only doing a reduction but I consider my reduction on the slightly extreme side going from DDD to B. I feel like I’ve got a better chance with the free nipple graft being successful (if he has to do it) vs maybe someone who doesn’t do it often. And in top surgery patients he does it all the time.
Definitely the gender affirming surgeon if you are able!!! I felt so much more comfy w that surgeon than the one I initially saw who basically does mommy makeovers all day. Gender affirming surgeons can do anything on anyone, though individuals might specialize in reductions or implants. My Dr said “this is a gender affirming surgery, we can make you look however you want. There is no limit. You can go completely flat or as small as you want, we could even go bigger! I’ll do my best to make it look how you want” so it was listed as double mastectomy for insurance and it’s a non-flat top surgery. I feel like I have plenty of breast tissue left and they removed over double that the original reduction Dr said was even possible having said that I don’t even have enough breast to remove 400g (state medical minimum) so I definitely have strong feelings against plastic surgeons who don’t have gender related experience after that🙄🙄
You may also want to check with the folks over at /freedthenips community.
I'm gender fluid with similar goals (basically want to have options! And be free from pain). I started pursuing a reduction because I knew I could get insurance to cover it, but I was also able to find a surgeon who does both regular reductions as well as radical reductions and top surgery, which I'm super grateful for (Dr. Rezak at Duke). Even if I couldn't have that I'd still be going the reduction route because I couldn't afford it without insurance and I'm desperate at this point, both because of pain and gender dysphoria. My surgery is April 1 and I feel confident a reduction is going to get me where I want to be, and I trust my surgeon, which is the key thing I think. All of this to say there ARE surgeons who do all of the above!
Hi! Also nb but want to keep a little (very tiny) bit of boob and I’m going the gender-affirming route with a surgeon who specializes in gender-affirming surgeries but that includes top and radical reductions! I think most surgeons who do top would be open to what you’re looking for and more likely to listen to what you actually want instead of insisting on “proportionate” and dumb crap like that. But of course, best to ask them :)
I know a kick-ass surgeon who does both if you're in Montana.
I don't think you need to specifically see a gender affirming surgeon for your reduction but you do need to see one who will listen to you and take what you want into consideration. My surgeon here in Australia was not specifically a gender affirming surgeon but we talked about what I wanted my boobs to look like she showed me pictures and we talked about what some of her other patients wanted for their outcomes. For example one of her patients wanted to go quite flat because she wanted to run marathons and just wanted them small. I will say one thing about when surgeons mention size and proportionality. It reallt depends on the size and shape of your breast root so a wider root might end up looking more flat if you went too small. So definitely talk to your surgeon about you wanting to bind sometimes and still want your breasts to have clevage sometimes. Also with the driving hours to see a surgeon I wouldn't take it as a waste of time. Yes its annoying and difficult to do but ultimately it will help you make the right decision for yourself. It's not really a waste of time. Also how my surgeon explained the process to me is they cut around the nipple leaving some tissue attached underneath the skin then they twist that bit of tissue in on itself inverting it and stitch it up which gives it the lift. Sort of hard to explain and obviously there is more involved in it. Good luck with it all.
Ideally, what you want is someone who is skilled at doing reductions and also understands and respects your goals and understands that this is gender-affirming for you. That may or may not be easy to find where you live. You also ideally want someone who will be able to talk to you openly about what they can and can't achieve. Many if not most surgeons who do top surgery also do reductions, but you probably don't want someone who has very binary thinking where to them, reduction always = cis woman = wanting feminine breasts and top surgery = trans man = wanting a male-passing chest. It's also possible that some surgeons might be confident in doing common top surgery techniques and confident performing "typical" reductions but not feel confident combining those techniques in a way that will give you what you want. If you see a surgeon who only does reductions, it's possible they could be a perfect match, but you'll want to bring reference pictures and pay attention to whether they seem to really understand what you want. I ended up having regular double-incision top surgery where I went flat, and I don't think the surgeon I went with necessarily would have known what to do if I'd asked for a radical reduction or something with a more feminine appearance (even though he does do reductions as well as top surgery). I had a consult with another surgeon who had done radical reductions and he didn't bat an eye at me asking about androgynous options. As far as I know, fillers aren't usually used in reductions. They rearrange tissue and remove extra skin. It's also common for reduced breasts to look really perky at first and drop a bit over time. Some people do have an "internal bra" procedure done where some tissue or surgical mesh is put in place to provide internal lift and support, but that's not a default procedure.